Horseshoe abscess associated with acute carpal tunnel syndrome: somebody wake up the hand surgeon.

The horseshoe abscess is a rare variant of flexor tendon sheath infections. It involves the tendon sheaths of the first and fifth digits, which communicate through the deep potential space of the wrist. Neural compression is possible, leading to an acute carpal tunnel syndrome. The approach to such patients should include empirical antibiotic coverage and urgent consultation with a hand surgeon to facilitate operative management.